Self-perceived assessment of nutritional status as a determinant of

Self-perceived assessment of nutritional status as a determinant of

original papers
Adv Clin Exp Med 2012, 21, 2, 225–233
ISSN 1899–5276
© Copyright by Wroclaw Medical University
Jolanta Mikołajczak, Ewa Piotrowska, Jadwiga Biernat, Joanna Wyka, Alicja
Żechałko-Czajkowska
Self-Perceived Assessment of Nutritional Status
as a Determinant of Health-Promoting
and Anti-Health-Promoting Behaviors of Adolescent Boys
Samoocena stanu odżywienia jako czynnik determinujący zdrowotne
i antyzdrowotne zachowania nastoletnich chłopców
Chair of Human Nutrition, Department of Agricultural Technology and Storage, Wrocław University of Life
and Environmental Sciences, Poland
Abstract
Background. Analyses were conducted for the effect of selected elements of lifestyle determining the attitude of
adolescent boys to health, care over good physical condition and own appearance against self-consciousness and
the real nutritional status of their bodies.
Objectives, Material and Methods. Investigations were conducted at Collective School No. 1 in Wrocław and
covered 369 boys (103 at the age of 16, 104 at the age of 17 and 162 at the age of 18) from Poland (Wrocław). The
boys were subjected to anthropometric measurements and nutritional status assessment. A questionnaire survey
referred to: 1) interests in own appearance, self-perceived assessment of body mass and nutritional status; 2) nutritional behaviors, applying a body mass-reducing diet, other “special diet” and dietary supplements; 3) the level of
physical activity; and 4) the use of stimulants (cigarettes, alcohol). Data was also collected on the educational status
of parents and the number of siblings, which were then analyzed for their effect on the above elements of lifestyle.
Results obtained were subjected to a statistical analysis.
Results. Proper body mass (BMI between 10th and 90th percentile) was observed in 81.8% of the boys; malnutrition
(BMI < 10th percentile) in 5.7% of the boys; whereas overweight and obesity (BMI ≥ 90th percentile) in 12.5% of the
examined boys. Analyses have also shown that 34.2% of the boys were evaluating their nutritional status, whereas
19.5% did not think about it. Only approx. half the examined pupils (51.0%) considered their body mass “fine”,
i.e. were satisfied with their body mass. A lack of satisfaction with their own appearance was declared by 21.4% of
the boys.
Conclusions. The self-perceived assessment of body mass was observed to diverge from the results of objective
analyses of the nutritional status of the boys. That factor was found to determine, to a considerable extent, behaviors of the pupils with respect to going on a body mass-reducing diet, taking dietary supplements and smoking
cigarettes. The study indicates that the nutritional status of youth should be monitored and that actions should
be undertaken to increase their awareness of the principles of a healthy lifestyle (Adv Clin Exp Med 2012, 21, 2,
225–233).
Key words: boys, lifestyle, nutritional status, self-perceived assessment of body mass.
Streszczenie
Wprowadzenie. Badano wpływ wybranych elementów stylu życia określających postawę nastoletnich chłopców
wobec zdrowia, dbałości o dobrą kondycję i własny wygląd wobec samoświadomości i rzeczywistego stanu odżywienia organizmu.
Cel pracy, materiał i metody. Badania prowadzono w Zespole Szkół Nr 1 z udziałem 369 chłopców (103 – 16 lat;
104 – 17 lat; 162 – 18 lat) z Polski (Wrocław). Wykonano badania antropometryczne i oceniono stan odżywienia uczniów. Badania ankietowe dotyczyły 1) zainteresowania własnym wyglądem, samooceny masy ciała i stanu
odżywienia; 2) zachowań żywieniowych, stosowania diety w celu obniżenia masy ciała, innej „specjalnej diety”
oraz suplementów diety; 3) poziomu aktywności fizycznej; 4) używek (papierosy, alkohol). Zebrano informacje
o wykształceniu rodziców, liczbie rodzeństwa i oceniono ich wpływ na powyższe elementy stylu życia. Wyniki
poddano analizie statystycznej.
226
J. Mikołaczak et al.
Wyniki. Prawidłową masę ciała (BMI między 10. a 90. percentylem) stwierdzono u 81,8% chłopców; stan niedożywienia (BMI < 10. percentyla) u 5,7%; nadwagę i otyłość (BMI ≥ 90. percentyla) u 12,5% badanej grupy. 34,2%
chłopców błędnie oceniło swój stan odżywienia, a 19,5% nie zastanawiało się nad tym. Tylko około połowa uczniów
(51,0%) uważająca, że waży „w sam raz” była zadowolona ze swojej masy ciała. Brak satysfakcji ze swego wyglądu
wykazywało 21,4% chłopców.
Wnioski. Samoocena masy ciała odbiegała od wyników obiektywnych badań oceny stanu odżywienia chłopców.
Czynnik ten w znacznym stopniu determinował zachowania uczniów w aspekcie stosowania diety odchudzającej,
suplementów diety i palenia papierosów. Należy monitorować stan odżywienia młodzieży i zwiększyć świadomość
zasad zdrowego stylu życia (Adv Clin Exp Med 2012, 21, 2, 225–233).
Słowa kluczowe: chłopcy, styl życia, stan odżywienia, samoocena masy ciała.
Adolescent youth is observed to increasingly
undertake attempts to assess of their self-perceived
nutritional status, the results of which are not always
consistent with those achieved by objective methods
of its evaluation. Attitudes to one’s own appearance,
body mass and nutritional status affect eating habits
and the level of physical activity in adolescents. The
youth implements unhealthy principles in order to
control their body mass. A lack of knowledge of recommendations for rational nutritional, a low-energy diet as well as those linked with daily load and the
quality of physical exercise is the cause of numerous
mistakes made in this respect [1, 2]. A multi-nation
survey demonstrated a differentiated percentage of
those slimming down depending on country and
region of the world. The number of those “being on
a diet” was observed to increase with age, i.e. from
12.0% in 11-year-old girls to 23% in 15-year-old
girls as well as from 7.0% to 9.0% in the respective
age groups of boys [3].
An ill-balanced diet, the use of stimulants and
a passive lifestyle lead to disturbances in nutritional
status and to development of nutrition-dependent
diseases [4, 5]. Overweight and obesity are diseases
that occur mainly in industrialized countries and
affect an ever-increasing number of young people.
Worldwide data shows that there are 155 million
schoolchildren with overweight and obesity, including 22 million obese children under 5 years
of age. Obesity currently affects approximately
30–45 million children and adolescents at the age
of 5–17 [6]. A report in 2006 estimated that by the
year 2010, one in ten children would be obese [7].
Investigations carried out amongst 5–11-year-old
children from the region of seven European countries and the USA demonstrated the fastest-growing changes towards an increase in excessive body
mass in Poland and England [6]. Apart from the
health-related consequences observed in the future, including arterial hypertension, dyslipidemia,
orthopedic affections, disorders in carbohydrate
metabolism, bronchial asthma, fits of sleep apnea
and risk of neoplasms, obese children suffer due
to psycho-social problems, a lack of acceptance in
their environment and low self esteem [7–9].
The health benefits resulting from regular
physical activity have already been widely documented [10–14]. An adolescent should spend at
least an hour a day actively. Straining exercises
should be performed two times a week in order to
model the structure of muscles, develop flexibility
and strengthen bones. Passive activities (TV, computer) should be limited to two hours a day [10].
The pursuit of body mass reduction may encourage some unhealthy behaviors, including: application of laxative agents, provoking vomiting
and application of drugs and stimulants as well as
lead to psychological problems [15–18]. Tobacco
and alcohol are the risk factors of metabolic and
developmental disorders, diseases and premature
death especially when their application starts at
a young age [19–21]. Observations conducted in
the USA have demonstrated that approximately
80% of adult smokers began their addiction in
adolescence [22]. To some adolescents, smoking is
a way to reduce body mass [23].
Once consumed by young people, alcohol
– included amongst narcotics – inhibits the function of the central nervous system and induces
changes in the brain in which intellectual and
emotional functions are still subject to maturation. In addition, it affects lipid metabolism in
the body, i.e. increases the concentration of triglycerides, blood coagulability, and is likely to
increase blood pressure, thus inducing changes
which are atherogenic in character [24, 25]. The
high energy value of alcoholic drinks disturbs the
energy balance in the body, thus leading to overweight and obesity. Alcohol is the most common
psychoactive substance amongst Polish youth.
Investigations show that 90.3% of 16-year-olds
and 99.6% of 18-year-old boys have already tried
alcohol [26].
The presented study was aimed at evaluating
elements of lifestyle determining the attitude of
adolescent boys to health, care over good physical
condition and their own appearance (self-control
of body mass, the use of special diets, dietary supplements, Food for Particular Nutritional Uses,
stimulants – cigarettes and alcohol, and physical
227
Self-Perceived Assessment of Nutritional Status in Adolescent Boys
fitness) depending on the self-perceived assessment
of body mass and their real nutritional status.
Material and Methods
The study was conducted from February till
April 2003 and from February till March 2004 in
a group of 369 boys attending Collective School
No. 1 in Wrocław (Poland). The school was selected for the study purposely as it was covered by
the program “A Health-Promoting School”, thus
in expectation of a greater wholesome awareness
of its students. Analyses covered all boys at the age
of 16–18 years. Individual consents were gathered
for their participation in questionnaire surveys and
biochemical analyses. The numbers of the boys in
particular age groups were as follows: 103 boys at
the age of 16 (27.9% of all subjects), 104 boys at the
age of 17 (28.2%), and 162 of boys at the age of 18
(43.9%). Out of all boys examined, 65.6% attended
the Senior Secondary School (73.8% of 16-yearolds, 60.6% of 17-year-olds and 63.6% of 18-yearolds), whereas the other subjects (34.4% of all boys)
attended the Specialized Vocational Senior Secondary School. The highest percentage of boys (30.6%
of all subjects) were attending classes of the computer science focus, followed by the general focus
(19.5%), social sciences focus (19.2%), economics
and administrative focus (12.5%), technical focus
(10.3%), humanities focus (6.0%) and natural science focus (1.9%). The majority of the boys (85.9%)
were living in Wrocław, whereas 6.5% of the subjects were dwelling in neighboring small towns,
and 7.6% in villages. Most of the boys (89.7%)
originated from families with more than one child,
58.8% of the subjects had one sibling, 21.4% had
two siblings, 5.4% had three siblings, and 4.1% had
four or more siblings. The boys surveyed originated from various environments, and their parents or caregivers were characterized by different
educational status, namely: 59.3% of mothers and
46.6% of father had secondary education, 23.6% of
mothers and 22.5% of fathers had university education and 17.1% of mothers and 30.9% of fathers
had primary and vocational education.
The nutritional status of the boys was evaluated based on the computed individual BMI values
using percentile charts and considering their age,
i.e. BMI between 10th and 90th percentile – proper
body mass, BMI < 10th percentile – malnutrition,
and BMI ≥ 90th percentile – overweight and obesity.
The declared amounts of alcohol beverages
drunk at one time, with consideration given to
their type, were evaluated according to the following criteria: A – (1–2 beers – 0.33 l; 1 glass of
wine – 100 ml; 1 glass of vodka – 25 g) – medium
amounts; B – (3–4 beers; 2 glasses of wine; 2 glasses of vodka) – high amounts; C – (5 or more beers,
3 or more glasses of wine, 3 or more glasses of
vodka) – very high amounts. Volumes of the alcoholic beverages were adopted as follows: 1 bottle of
beer – 0.33 l; 1 glass of wine – 100 ml; and 1 glass
of vodka – 25 g.
The questionnaire used in the study was composed at the Department of Human Nutrition,
Wrocław University of Life and Environmental
Sciences. The conducted validation enabled its
verification and imparted its accuracy in individual and cohort studies.
The results obtained were subjected to a statistical analysis using Statistica 7.1 software by
StatSoft Inc. USA. Their evaluation as ordinal and
nominal data was conducted by means of contingency values. Dependencies between the variables
were analyzed with the Chi2NW test; whereas correlations – with Spearman’s correlation coefficient
(R); and the level of statistical significance was adopted at p < 0.05.
Results
Table 1 presents the results of the self-perceived
assessment of body mass of the 16-18-year-old boys
(n = 369) in respect of their nutritional status and
elements of lifestyle. Mean body mass, expressed
by the value of the 50th percentile, reached 68.0 kg
(min. 41.0; max. 111.0 kg), at a mean body height
of 1.80 m (min. 1.6 m; max. 2.0 m), and BMI value
for the 50th percentile reached 21.2 kg/m2 (min.
15.8 kg/m2; max. 34.8 kg/m2). Most of the boys
(81.8%) had proper body mass, whereas malnutrition was noted in 5.7% and overweight and obesity
in 12.5% of the subjects examined. No statistically
significant differences were demonstrated between
the age groups compared.
In the examined group of 16–18-year-old,
78.6% of the boys declared that they were satisfied
with their appearance, however only 27.1% of the
subjects declared that they pay much attention to
their body mass. No statistically significant differences were reported in the satisfaction of their own
appearance depending on BMI value, yet the differences appeared significant in terms of the opinions
on their own body mass (p = 0.00003). Amongst
the boys examined, 46.3% were of the opinion that
their body mass was “fine”, 25.7% claimed to be
too thin, 8.4% to have too high body mass, and
19.5% not to think about it at all. Only approximately half the students (51.0%) who claimed that
their body mass was “fine” were satisfied with their
appearance. The other boys did not accept their
Table 1. Self-perceived assessment of body mass regarding to nutritional status and components of lifestyle by 16–18-yearold boys (n = 369) [%]
Tabela 1. Samoocena masy ciała w odniesieniu do stanu odżywienia i elementów stylu życia 16–18-letnich chłopców (n = 369) [%]
Lifestyle components and environmental
determinants
(Elementy stylu życia i środowiska)
p < 0.05
Age – years
(Wiek – lata)
Nutritional status c,f
(Stan odżywienia)
Paying much attention
to own body mass c,e,f,g,h,k
(Nacisk na własną
masę ciała)
My body
mass is fine
I’m too
fat
I don’t think
about it
25.7
46.3
8.4
19.5
100
5.7
15.2
2.2
4.9
27.9
17
7.9
13.2
1.1
6.0
28.2
18
12.2
17.9
5.1
8.7
43.9
2.7
1.6
0.3
1.1
5.7
BMI 10th–90th
percentile
21.4
40.9
5.4
14.1
81.8
BMI ≥ 90th
percentile
1.6
3.8
2.7
4.3
12.5
9.8
11.6
4.1
1.6
27.1
no
8.4
19.0
2.4
11.6
41.5
I have no opinion about it
7.6
15.7
1.9
6.2
31.4
17.3
40.1
4.6
16.5
78.6
8.4
6.2
3.8
3.0
21.4
0.5
1.9
1.1
1.1
4.6
16
BMI < 10th
percentile
yes
Satisfaction of own
appearance c,d,j
(Satysfakcja
z własnego wyglądu)
yes
Applying a slimming
diet b, c, d,k
(Korzystanie z diet
odchudzających)
yes
Applying a “special
diet” d,j,g,f,l
(Korzystanie
ze specjalnych diet)
Dietary supplements
c,d,h,k,m
(Suplementy diety)
–
SS
SS
SS
no
SS
no, but I should
0.5
3.0
3.2
0.9
7.6
no
24.7
41.5
4.1
17.6
87.8
23.3
40.1
6.8
18.4
88.6
reason: maintaining body mass
0.8
0.8
0.8
0.0
2.4
reason: disease
0.3
0.0
0.0
0.3
0.5
reason: religious
or ethical beliefs
0.0
0.8
0.0
0.3
1.1
reason: care over
good condition
and health
1.4
4.6
0.8
0.5
7.3
6.0
13.0
0.5
3.5
23.0
19.8
33.3
7.9
16.0
77.0
24.9
43.9
7.9
17.9
94.6
0.8
2.4
0.5
1.6
5.4
2.7
5.1
0.5
1.6
10.0
occasionally
16.3
32.2
6.0
12.5
66.9
1–2 times a week
5.4
8.9
1.1
3.8
19.2
1.4
0.0
0.8
1.6
3.8
8.7
11.9
2.7
6.2
29.5
17.1
34.4
5.7
13.3
70.5
no
yes
–
SS
no
Physical activity
(Aktywność fizyczna)
yes
Frequency of alcohol
consumption a,c,j,l,m
(Częstotliwość
spożycia alkoholu)
never
–
no
SS
> 5 times a week
Smoking cigarettes e,i,j
(Palenie tytoniu)
Total
group
(n = 369)
(Cała
grupa)
I’m too
thin
All group
m
Opinion on own body mass
(Samoocena masy ciała)
yes
no
–
Statistical significance (SS) determined by Chi2NW (p < 0.05) correlated with: a – age of the boys, b – BMI value, c – opinion
on own body mass, d – paying much attention to own body mass, e – satisfaction with own appearance, f – applying a slimming diet, g – applying dietary supplements, h – physical activity, i – alcohol consumption, j – tobacco smoking, k – applying “a special diet”, l – educational status of mother, m – education status of father, n – number of siblings.
Istotność statystyczna wyznaczona za pomocą testu Chi2NW (p < 0,05) korelowała z: a – wiekiem chłopców, b – wartością
BMI, c – samooceną masy ciała, d – naciskiem na własną masę ciała, e – satysfakcją z własnego wyglądu, f – stosowaniem
diety odchudzającej, g – spożywaniem suplementów diety, h – aktywnością fizyczną, i – spożywaniem alkoholu, j – paleniem
tytoniu, k – stosowaniem specjalnej diety, l – wykształceniem matki, m – wykształceniem ojca, n – liczbą rodzeństwa.
229
Self-Perceived Assessment of Nutritional Status in Adolescent Boys
Fig. 1. Opinion of the boys
(n = 369) on their figure vs.
objective assessment of their
nutritional status acc. to BMI
values. Statistically significant
correlation at p < 0.05
50%
% of the group
40%
30%
Ryc. 1. Opinia chłopców
(n = 369) na temat własnej sylwetki a obiektywna ocena stanu
odżywienia wg wskaźnika BMI.
Zależność istotna statystycznie
przy p < 0,05
20%
10%
0%
malnutrition
I'm too thin
correct body mass
my body mass is "fine"
overweight, obesity
I'm too fat
own appearance, claiming that they were too thin
(39.2% of all subjects) or too fat (17.7%).
The nutritional status of the boys, evaluated by
means of the BMI values with the use of percentile
charts, differentiated statistically significantly (p
= 0.00025) the opinion of the boys on their own
figure. Many of the subjects did not assess their
nutritional status correctly (Fig. 1). Only half of
the boys with proper body mass claimed that their
body mass was “fine”; 26.2% of them were of the
opinion that they were too thin and 6.6% that they
were too fat. Approximately half (47.6%) of the
boys with malnutrition (BMI < 10th percentile)
correctly evaluated their figure, yet there were also
some who claimed that their body mass was “fine”
(28.6%) or that they were too fat (4.8%). Amongst
the boys with overweight and obesity (BMI ≥ 90th
percentile) only 21.7% were aware of that fact,
30.4% claimed that their body mass was proper,
and 13.0% that they were too thin.
A statistically significant (p = 0.00176) difference was demonstrated between the nutritional
status according to the BMI criteria and applying
a body mass-reducing diet in the last 12 month before the study. The most numerous group of boys
with BMI ≥ 90th percentile (15.2%) were using a lowenergy diet, as compared to the boys with BMI of
the 10th–90th percentile (3.0%) and those with BMI
< 10th percentile (4.8%). Approximately 15% of the
subjects with overweight and obesity were of the
opinion that they should modify their eating habits
in order to reduce excessive body mass.
Similar statistically significant (p < 0.00001)
correlations were demonstrated between applying
a slimming diet and the opinion of their own body
mass. Analyses showed, that amongst the boys
considering themselves as obese, approximately
13.0% were already applying diets to reduce their
body mass, and as much as 38.7% of that group expressed the opinion that they should go on a diet.
The BMI values and opinion of their own
I don't think about it
body mass demonstrated a weak but statistically
significant mean correlation with applying a body
mass-reducing diet (R = 0.16).
Out of all the boys examined, 11.4% were applying “special eating habits” due to various reasons: religious or ethical (1.1%), care about having
a good figure (2.7%), maintenance of good physical conditions and the plenitude of health (7.0%),
and health condition (0.5%). Amongst the boys on
a “special diet”, analyses showed significantly more
frequent attacks of hunger (p = 0.0345), greater
care of their own body mass (p = 0.00021), and
more interests – hobbies that were being developed (p = 0.0536). No significant differences were
demonstrated in the use of stimulants (cigarettes
and alcohol) between that group of boys and the
other subjects.
Obligatory classes of physical education at
school covered 4 school hours (45 min) a week.
Approximately 5.5% of the examined boys had
a physician’s exemption from sports classes. No
statistically significant differences were found in
their frequency in particular age groups. The majority of boys (94.6%) were regularly attending the
obligatory classes at school, including 82.7% of the
boys who also participated in extra sports activities
on their own (football, volleyball, basketball, gym,
etc.). A statistically significant (p = 0.02569) difference was demonstrated in the amount of time
devoted to sports activities and using dietary supplements. The vitamin dietary supplements were
applied exclusively by the most physically-active
boys, namely those who were undertaking sports
activities in addition to classes of physical education at school (p = 0.00469).
A considerable percentage of the boys examined were smoking cigarettes (29.4%), including
25.2% of the 16-year-olds, 26.9% of the 17-yearolds and 34.0% of the 18-year-olds. Amongst all
the boys who reported regular smoking, approximately 4% were having from 1 to 5 cigarettes a day,
230
8.9% were having from 5 to 10 cigarettes, and 6.5%
were smoking over 10 cigarettes a day. No statistically significant differences were demonstrated in
the habit of smoking as affected by the age of the
respondents, educational status of their parents,
their nutritional status and level of physical activity. Analyses have shown, however, that amongst
the group of smokers, a significant (p = 0.018) part
did not have any problems with the acceptance of
their own appearance (70.6%). The habit of smoking was demonstrated significantly less frequently
(p = 0.01243) in the boys on a “special diet” linked
with the maintenance of good health and condition, as compared to the other subjects. In that
group, the boys who reported smoking cigarettes
were usually doing it occasionally (p = 0.03579).
Approximately 90% of the surveyed boys had
already tried alcohol. The χ2 test demonstrated
statistically significant differences in the frequency of alcohol consumption depending on the age
of the respondents and educational status of their
parents (p < 0.05). Alcohol was most frequently,
i.e. 1–2 times a week and over 5 times a week,
consumed by the 18-year-old respondents (26.5%
and 4.9% of those groups, respectively), and by
students whose parents had secondary or higher
education. The highest percentage of the youngest boys (16.5%) reported not consuming alcohol
at all. Usually, the boys were drinking alcohol occasionally (66.9%), yet approximately 20% of the
respondents consumed alcohol 1–2 times a week,
and approximately 4% more than 2 times a week.
Amongst the alcohol beverages, the most popular
turned out to be beer (85.4% of all answers), followed by vodka (46.3%) and wine (28.2%). The
choice of beer and wine was significantly dependent on the age of the respondents (p < 0.05). Beer
was consumed by 90.7% of the 18-year-olds, 86.5%
of the 17-year-olds and by 75.7% of the 16-yearolds, whereas wine by 22.8%, 41.3% and 23.3% of
the boys from the respective age groups. Although
most of the boys reported drinking alcohol occasionally, its single ration drunk was found to be
high. High single drink consumption of vodka was
declared by approximately 38.0 % of the group,
that of beer by approximately 23.0% and that of
wine by approximately 16.0% of the respondents.
Approximately ¼ of the boys reported drinking
alcohol regularly. It was demonstrated that the
frequency of alcoholic beverage consumption was
affected by the educational status of both mother
(p = 0.00565) and father (p = 0.01615). Most frequently, alcohol was consumed by the students
whose parents had secondary education and by
those whose fathers had vocational education.
Statistically significant (p = 0.01419) differences were shown between the opinion of their
J. Mikołaczak et al.
own body mass and the frequency of alcohol consumption. The boys who claimed that their body
mass was “fine” (11.1%) or those claiming to be
too thin (10.5%) usually did not consume alcohol
at all. A very high frequency (more than 5 times
a week) of alcohol consumption was demonstrated
for the most numerous group of boys who claimed
that they were too fat (9.7%) and for those who did
not pay attention to their body mass (8.3%). In that
group, there was one boy who claimed his body
mass was proper. No statistically significant differences were found between opinion of one’s own
body mass and the level of physical activity and the
frequency of cigarettes smoking. Significant differences were shown, however, between the number
of smoked cigarettes and BMI value (p = 0.03493).
A relatively small group of boys (16.8%) with proper BMI were drinking large amounts of alcohol as
compared to the boys with malnutrition (33.3%)
and those with BMI > 90th percentile (30.4%).
Discussion
Youths at the age of adolescence are interested
in their own appearance and often do not accept
themselves. The girls are striving for a slender figure promoted by the media, whereas the boys are
in the pursuit of a muscular, athletic appearance.
Young people are trying to reach their ideals in
a variety of ways, often by means of unbeneficial,
improper modifications of their daily diets, application of dietary supplements and Food for Particular Nutritional Uses, the use of stimulants, and
physical activity [15, 27, 28].
International investigations by the WHO –
HBSC 2001/2002 [3] referring to nutritional behavior worldwide have demonstrated that 1/5 of
the total population of boys at the age of 11 and
¼ of the population of boys at the age of 15 were
not satisfied with their appearance. Amongst the
15-year-old boys from Poland and Slovakia, that
percentage has increased to as much as 35% of
the population of boys at the age of 15. Results
obtained in this study demonstrated that approximately 20% of the examined boys did not accept
their appearance, claiming that they were either
too thin or too fat.
Overweight and obesity are the most common
health problem occurring amongst children and
youth. In the countries of Northern Europe, excessive body mass is reported in 10–20% of young
people, whereas in Southern Europe that percentage is considerably higher and ranges from 20% to
35% [6]. Other surveys indicated that in Poland,
as well as in Sweden, Belgium, Bulgaria, the Czech
Republic, France, Germany and Denmark, over-
Self-Perceived Assessment of Nutritional Status in Adolescent Boys
weight and obesity affects 15–19% of children at
the age of 7–11 [7, 18]. In light of these results, in
the present study, the percentage of boys with excessive body mass (approximately 12%) was found
to be slightly lower.
A positive aspect is that the adolescents are interested in health-promoting changes of their lifestyle, which however might become detrimental to
their health if introduced without sound preparation, knowledge and control. Despite overweight
and obesity on such a large scale, adolescents are
often wrong in the self-perceived assessment of
their nutritional status, and they may happen to
correct it unnecessarily and inappropriately. In the
reported survey, only half of the respondents with
the correct body mass were aware that their body
mass was “fine”. In turn, the application of a slimming diet was reported in approximately 5% of the
boys with malnutrition and in 3% of the boys with
correct BMI value.
Experiments with slimming diets are likely to
pose serious health consequences. A nation-wide
survey demonstrated diagnosed cases of anorexia
nervosa and even 2–3-times higher incidence of
bulimia in every school examined [29].
Results of international investigations have
shown the United States to be the country with
the highest percentage of 15-year-old boys who
have tried to lose weight (20.8%). Other countries
with respect to the percentage of teenagers having been on a diet included: Hungary (11.2%),
Denmark (10.9%), Israel (10.7%), Greece (10.3%),
Malta (9.6%), and Poland (6.7%) [3]. The results
of the present study confirmed lesser interest in
body mass control in Poland than in other countries, since approximately 5% of the respondents
reported applying a slimming diet, and simultaneously 8% of the boys were willing to undertake
such actions. Research by Nystrom [28] demonstrated that 49% of the examined girls and 38%
of the examined boys have tried to lose weight by
modifying their diet. In that population, the intake
of fruits and vegetables was observed to decrease
considerably as compared to the control group.
A study by Lowry [30] indicated that over the time
span of years 1991 to 2001 a significant increase
was noted in the population of boys undertaking
attempts at body mass reduction (22.7–28.8%) and
willing to maintain their current body mass (17.8–
21.5%). To this end, they were most frequently increasing the load of straining exercises.
The proper number of hours devoted to physical activity is of crucial significance to the health
and development of adolescents [10, 13, 14]. The
results of the reported study demonstrated that 5%
of the 16–18-year-old boys were exempted from
classes of physical education. That percentage ap-
231
peared to be slightly higher as compared to the
boys from Warsaw (3%). In a considerable percentage of Polish children and youth (60–70%),
the level of physical activity is unsatisfactory, since
it is often limited to barely obligatory classes of
physical education at school (4 × 45 min a week)
[29–30]. The conducted study demonstrated that
approximately 12% of the boys were undertaking
physical activities only within school classes. An
international study of the HBSC conducted in 35
countries indicated that 2/3 of the youth did not
reach the recommended level of physical activity
[3]. In turn, a review work by Bates [11] from investigations of the Canadian Community Health
Survey (CCHS) showed that in the years 2000/01
over half (56.0%) of 12–19-year-old Canadians
were leading an insufficiently active lifestyle. The
Canadian Fitness and Lifestyle Research Institute estimated that the level of physical activity in
82.0% of Canadian adolescents did not fulfill international recommendations [31]. On the other
hand, results of the Youth Media Campaign Longitudinal Study (YMCLS) pointed to low physical
activity in American adolescents, since 61.5% of
the population of 9–13-year-olds did not participate in any physical activity after school [32].
The use of stimulants poses severe health and
social problems when it begins at an early age [33–
35]. In the presented study, as little as 10.0% of the
16–18-year old boys did not drink alcohol. In turn,
66.9% of the respondents reported consuming it
only occasionally, however the amounts of alcohol
drunk at one time appeared to be very high. Statistical surveys conducted in Poland indicate that
45% of 15–19-year-olds have already drunk alcohol. Approximately 10% of teenagers were shown
to consume it 1–2 times a week, whereas 22.6% of
adolescents drink it 1–3 times a month [36]. The
highest percentage of 11-year-old boys regularly
drinking alcohol was recorded in Israel and Italy
(approximately 18% of the population), whereas
amongst boys at the age of 15–16 – in Denmark
(66%), Greece (54%), Great Britain and the Czech
Republic (53%). In contrast, the lowest percentages of drinking adolescents were reported in Finland, Greenland, Norway and Portugal (from 0.3
to 2.7% of the population) [37].
In the presented study, 29.4% of the boys
were demonstrated to smoke cigarettes, including 19.5% who were smoking at least one cigarette
a day. Those findings were similar to results of the
HBSC survey [3], where 22.0% of the examined
boys were shown to smoke cigarettes every day.
Attention was paid to the young age of nicotine
initiation, i.e. 15% of the population of 11-yearolds, 40% of the population of 13-year-olds, and
62% of the population of 15-year-olds. The highest
232
J. Mikołaczak et al.
percentage of the population of smoking 11-yearolds was reported in Latvia, Lithuania and Greenland (approximately 42.0%), Estonia (37.0%), and
Poland (27.2%), whereas the lowest was in Greece
(5.2%), on Malta and in the USA (approximately
8.5%), Belgium, Canada and Italy (approximately
12%). The habit of tobacco smoking displays an
upward tendency in a number of countries. For instance, in Lithuania the number of smoking teenagers increased from 15% in 1997 to 27% in 2002
[3]. In the present study, however, no correlation
was confirmed between the habit of smoking and
a lack of satisfaction with their own appearance
and applying “a slimming diet”, which has been indicated in investigations of other authors [15–18].
The authors concluded that a lack of satisfaction with their own appearance was expressed by
21.4% of the boys examined, and 53.4% of the respondents claimed that their body mass was unsatisfactory. Not all the boys surveyed evaluated
their body mass consistently with results of objective methods of nutritional status assessment, and
the opinion on their own appearance and body
mass was found to determine their behavior with
respect to applying a body mass-reducing diet,
dietary supplements and smoking. The boys paying attention to their body mass were observed to
significantly more frequently modify their eating
habits, to more often use dietary supplements, especially preparations containing minerals, as well
as to less frequently smoke cigarettes and drink
alcoholic beverages. Secondary and higher education of parents was found to significantly affect
the use of dietary supplements and “special diets”
by the boys examined. A considerable part of the
boys were using stimulants, i.e. alcohol (90.0% of
the population examined) and cigarettes (29.5%),
which in their adult life might result in severe
health problems, cardiovascular complication and
neoplasms in particular.
Acknowledgements
None of the authors had any financial interest or support for this paper.
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Address for correspondence:
Joanna Wyka
Chair of Human Nutrition
Department of Agricultural Technology and Storage,
Wrocław University of Life and Environmental Sciences
Chełmońskiego 37/41
51-630 Wrocław
Poland
E-mail: [email protected]
Conflict of interest: None declared
Received: 14.07.2011
Revised: 2.01.2012
Accepted: 29.03.2012